Provider Demographics
NPI:1457314528
Name:SCOTT & WHITE CLINIC
Entity Type:Organization
Organization Name:SCOTT & WHITE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VP, RCO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-215-9719
Mailing Address - Street 1:PO BOX 848496
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8496
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1815 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6728
Practice Address - Country:US
Practice Address - Phone:254-724-2020
Practice Address - Fax:254-724-9571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT & WHITE OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-10
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1598088-01Medicaid
TX4356110003OtherRR/MEDICARE
TX4356110003OtherRR/MEDICARE
TX4356110003Medicare NSC